摘要:

Mood disorders are serious chronic illnesses that are the leading cause of disability worldwide. Up to two-thirds of all people with a mood disorder are undiagnosed. In the US, there are three suicides for every two homicides, with 70% of these deaths attributed to untreated depression. Mental health advocacy organizations play an important role in the management of these disorders by urging those who are undiagnosed or untreated to seek treatment.Stigma is the number one barrier to mental healthcare, according to the US Surgeon General. Advocacy groups work to eliminate the stigma surrounding mental illness in order to encourage more people to seek treatment. They have a role in disease management as they enhance communication between patients and healthcare providers, an area in which studies have shown a significant gap in perceptions. Advocacy groups educate people so that they can play an active role in their own treatment plans. It has been demonstrated that participation in patient support groups increases patient compliance with treatment plans and decreases incidences of hospitalization for the illnesses.A critical role in disease management is patient advocacy for improved access to care, so that those needing treatment can actually receive it. Finally, mental heath advocacy groups have a role in managing the disease through ‘grassroots’ efforts to promote expanded research for better treatments, and eventually cures, for mental illnesses.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

End-stage renal disease (ESRD) is relatively rare, but very costly. The ESRD population in the US is elderly, over 40% have diabetes mellitus, and most have additional comorbid conditions. Concerns about the quality and cost of care for people with ESRD in the US prompted the Healthcare Financing Administration (HCFA) to launch a demonstration project to determine whether disease management might improve care at reduced cost. It also stimulated health plans in the private sector to begin contracting with newly formed ESRD disease management organizations (DMOs).We describe the clinical information system developed by one such organization, RMS Disease Management, an affiliate of Baxter Healthcare Corporation. The system was designed to function within disparate medical care delivery systems and regions, without adding work for providers or health plans. A point-of-care system was implemented using a client server configuration. Data were entered on laptops and uploaded over high-speed lines to a central site. The system was developed over 14 months and implemented in 12 regions in 1998 under a contract with Humana, a national health plan. Highly experienced, locally recruited nephrology nurses co-ordinated care and entered data. The data included standard quality indicators, performance measures and key outcomes, along with data on patient assessment, care management, and comorbid conditions.We have compiled 35 000 months of patient care experience in the past three years, and entered 4000 patients with ESRD into the program. The system has provided comparisons of data at the regional and national levels, an independent reference for auditing claims, rapid turn-around of data to drive outcomes management, and the ability to link all components of care management. The system configuration is scalable and has functioned well across multiple sites of care while maintaining the privacy and security of patient data.Future plans include migration to an internet-based platform, adoption of hand-held devices for data entry, and development of an Internet site where patients, their caregivers and their providers can interact. The system is designed to accomodate the evolving scope of disease management for ESRD, broadening to embrace multiple comorbid conditions and increasing its focus on prevention wellness.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Hypertension, an insidious condition affecting approximately 50 million US adults, remains a central factor contributing to cardiac and other target organ disease. Despite increased detection and numerous therapeutic advances, three out of four people with hypertension in the US have uncontrolled or poorly controlled blood pressure. While hypertension is a leading reason for primary care office visits and antihypertensive medications are widely prescribed, most individuals are not achieving goal systolic/diastolic blood pressure of 140/90mm Hg or less. While the definition of adequate blood pressure control varies in different countries, the problem of inadequate control is universal. Numerous barriers contributing to the suboptimal health outcomes have been recognized, including issues related to healthcare providers as well as patient compliance with medication and lifestyle changes.Recently, healthcare provider systems and health plans have turned to disease management strategies to better address quality and outcomes issues in hypertension management. Disease management, a systematic clinical improvement process, encompasses provider and patient education employing national or locally developed best practice guidelines and behavioral interventions coupled with close monitoring of clinical processes and outcomes of care. Disease management programs seek to define a comprehensive and coordinated approach to care across multiple providers and patient subgroups. Through risk assessment and stratification, patients at higher risk of complications can be identified, and customized intensive care support can be offered. Other types of intervention for lower risk individuals include brief visits with a cardiovascular educator or care manager, group classes, or self-instructional programs. Several successful programs initiated by healthcare systems and health plans are described.Adequate blood pressure control is essential to reduce cardiac, renal, and stroke disease later in life. However, large numbers of individuals must be effectively managed for years or decades to achieve reductions in complications and cost savings. Unlike more acute conditions that frequently result in hospitalization and loss of function, the immediate cost offsets of hypertension disease management efforts are less defined, although the eventual savings to society could be vast. Less costly methods to promote healthy outcomes across large, relatively stable populations are needed. Automated systems employing clinical decision support at the point of care and internet-based patient support strategies offer the hope that comprehensive, individualized disease management for hypertension can be affordable as well as effective. In the meantime, the fact that the National Committee on Quality Assurance has included blood pressure control as a future measure of health plan performance will almost certainly lead to the expanded development of hypertension disease management initiatives.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

BackgroundOsteoporosis is considered a disease that affects elderly women. Younger, working-aged women are seldom considered to be at risk, although low bone mass may occur at menopause or even earlier. Bone density testing for working women may therefore be considered of low priority for both women and their employers, especially if they perceive that there is a low risk of having low bone density at this age. We have designed a project to test bone density of women at their worksites.ObjectiveTo:create a method to detect silent bone loss in an employed population of women at their worksite;create a service to provide education and assist in compliance with management of low bone density for those affected;measure the effectiveness of these interventions.Study design and methodsThis study is a collaboration of an employer, the managed care organization, which provides healthcare coverage for this employer, and a pharmaceutical company which has long been involved in bone density research. We performed bone density screening of working women at their worksites who, based on a risk assessment, were potentially at risk of osteopenia or osteoporosis. Forearm bone density was assessed for each woman. For those women found to have low bone mass, a series of interventions, including worksite counseling and periodic telephonic follow-up, was provided to help them understand more fully their screening results and the need for interventions, including lifestyle changes, and follow-up with their primary care physicians for diagnosis and treatment. Data were collected before and after the interventions for each woman to measure outcomes, compliance and satisfaction with the screenings and interventions.Participants52 women employed by Sara Lee Corporation who participated in the healthcare trial and were found to have low bone density. All agreed to participate in the year-long interventions.ResultsWe found that these women reported increased knowledge about low bone density, compliance with their medications, and lifestyle habits following screening, counseling and periodic telephonic follow-up. In addition, as a result of the screenings performed, a significant proportion of these women (with low bone mass) were confirmed to have osteopenia or osteoporosis by their physicians, and started on therapy. Satisfaction with the screening process and telephonic management was uniformly high, with >95% of the women rating the services of the project as ‘good’ or ‘excellent’.ConclusionA worksite-based bone density testing method such as this was well received by those who participated. It led to improved detection and treatment of a group of younger, working-aged women who may have otherwise not undergone such testing until a much later age, if at all. This earlier detection and treatment may prevent further loss of bone mass and likelihood of clinical fracture. The collaboration between an employer, a managed care organization, and a pharmaceutical company enhanced the design and delivery of a functional project for a worksite-based bone density screening and contributed largely to its success.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

BackgroundTo meet the challenge of an aging population, providers and payors must optimize chronic wound care outcomes and contain costs.ObjectiveTo explore the costs, outcomes, and effects of outcomes on costs of pressure and venous ulcer woundcare protocols.DesignModeling study using outcomes from a literature review.MethodsThe cost of 12 weeks of wound care was modeled for a hypothetical managed-care plan. This included 100 000 covered lives and used a peer-validated wound care protocol. Only modalities with a pooled evidence base of at least 100 wounds were used to populate the model. Costs excluded supportive treatments.Results26 studies of three pressure ulcer protocols (n = 519) and three venous ulcer protocols (n = 883) qualified for inclusion in the models. After 12 weeks, the weighted average proportion of ulcers healed, and cost per ulcer healed, ranged from 48 to 61% and from $US910 to $US2179 (2000 values) for pressure ulcers, and from 39 to 51% and $US1873 to $US15 053 for venous ulcers. For a hypothetical managed-care plan, the difference between the least and most cost-effective modalities was $US1.9 million for pressure ulcers and $US5.8 million for venous ulcers. Observed differences were generally attributable to variances in outcomes and cost differences related to frequency of dressing changes. Pressure ulcer care takes place in inpatient care settings; venous ulcers are managed on an outpatient basis. Physician visit frequencies are once every four weeks for pressure ulcers and once each week for venous ulcers. Wound sizes ranged from 2.5cm2to 5.6cm2for pressure ulcers and 5.4cm2to 10cm2for venous ulcers. All patients with pressure ulcers required pressure relief, nutritional support and incontinence management; venous ulcers required gradient compression. Costs per patient healed were lowest for pressure ulcers with hydrocolloids and highest with saline gauze (this is a manpower issue). Costs to heal venous ulcers were highest with human skin construct and lowest for 12-week management with hydrocolloid.ConclusionsDespite the limitations of the models (as a result of incomplete study data), this analysis confirms that defining wound care costs solely as cost of products used is inaccurate and can be expensive.

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2001

数据来源: ADIS